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Speaker of the House Paul Ryan (R-WI) called President Donald Trump this afternoon and said that he needed to pull the American Health Care Act. He didn’t have the votes.

In his press conference today he said:

You’ve all heard me say this before: Moving from an opposition party to a governing party comes with growing pains. And well, we’re feeling those growing pains today.

We came really close today, but we came up short. I spoke to the president just a little while ago, and I told him the best thing that I think to do is to pull this bill, and he agreed with that decision. I will not sugar coat this: This is a disappointing day fo us. Doing big things is hard. All of us. All of us—myself included—we will need time to reflect on how we got to this moment, what we could have done to do it better.

But ultimately, this all kind of comes down to a choice. Are all of us willing to give a little to get something done? Are we willing to say yes to the good—to the very good—even if it’s not the perfect? Because if we’re willing to do that, we still have such an incredible opportunity in front of us.

There remains so much that we can do to help improve people’s lives. And we will.

Because, I got to tell you, that’s why I’m here. And I know it’s why every member of this conference is here: to make this a better country. We want American families to feel more confident in their lot in life. We want the next generation to know that, yes, the best days of this country are still ahead of us.

I’m really proud of the bill that we produced. It would make a dramatic improvement in our health care system and provide relief to people hurting under Obamacare. And what’s probably most troubling is the worst is yet to come with Obamacare.

I’m also proud of the long, inclusive, member-driven process that we had. Any member who wanted to engage constructively, to offer ideas, to improve this bill, they could. And I want to thank so many members who helped make this bill better. A lot of our members put a lot of hard work into this.

I also want to thank the president, I want to thank the vice president, I want to thank Tom Price, Mick Mulvaney, and the entire White House team. The president gave his all in this effort. He did everything he possibly could to help people see the opportunity that we have with this bill. He’s really been fantastic.

Still, we have to do better. And we will. I absolutely believe that. This is a setback. No two ways about it. But it is not the end of this story.

Because I know that every man and woman in this conference is now motivated more than ever to step up our game. To deliver on our promises. I know that every one is committed to seizing this incredible opportunity that we have. And I sure am.

It’s easy to get swept up in the tactical failures and daily horse-trading and nightly Congressional Budget Office estimates, but the real problem Republicans are facing is that they don’t like their own bill. The Affordable Care Act survived its many, many near-death experiences because, fundamentally, Democrats believed in it, they wanted it to pass, and they thought it important enough to imperil (and ultimately sacrifice) their majority over.

The plan Paul Ryan built in secret has few friends. Conservatives think it leaves too much of Obamacare in place. Moderates blanch at the 24 million it will leave uninsured. Wonks shudder at its slipshod, hasty construction. Experts from all three of Washington’s major conservative think tanks — the American Enterprise Institute, the Heritage Foundation, and the Cato Institute — oppose it. The latest polling shows merely 17 percent of Americans support it.

He also pointed out the time Democrats invested in passing Obamacare (from 9 to 13 months). President Trump and this new Congress has only been at this two months. It also doesn’t help that it is clear from the very first page that the bill wasn’t going to repeal Obamacare, but merely “fix” it. Start there and then from a clean slate talk about reforms that will actually not only lower health insurance premiums, but lower the cost of health care. Keep it simple. Tinkering with the edges of Obamacare just creates a more convoluted mess out of what is already a convoluted mess.

That wasn’t what many of us have been promised since 2010. We were promised a full repeal and that is what we expect.

4 comments

Shane, I agree with everything in your post. But I don’t see a path to extricate the health care system from Obamacare, and I’m afraid that we will end up living with it, like so many other entitlements. There are a lot of great ideas out there that would bring about free-market reforms, but none of them seem to command a sufficient consensus to be enacted into law. Like all good ideas, they involve tradeoffs and some risk; politicians are risk-averse. Sorry to be a Cassandra in the midst of the jubilation

Obamacare was designed to fail and be replaced with single payer healthcare. The Republicans are falling into the Democrat trap. Just Repeal. No Replace is needed. Let the insurance market work without governmental interference.

There is going to be no fiscally sound healthcare system where: 1) People will always receive emergency and necessary care regardless of ability to pay and… 2) Anyone can opt out of paying for care (i.e. not carry enough insurance to cover their care).

Add to that mix, the reality that some people and families will be unable to cover the costs of their care.

Point 1 is assumed out of basic human compassion and because we are not a third world nation. Point 2 seems to be a position held by many in the GOP: The ‘anti-mandate’ position. This honestly makes no sense to me as it’s neither a fiscally sound position nor an ideal of personal responsibility.

Whether one chooses a ‘free market’ approach + some form of subsidy, a purely public system, or something in-between is less relevant than coming to agreement on two simple starting points:

1) We do want to ensure essential medical coverage to all citizens regardless of ability to pay and: 2) Everyone who can purchase or fund coverage is required to do so.

Is it an entitlement? Certainly for some. But it’s more like a universal coverage requirement. The costs will be extracted one way or another (e.g. direct pay, employer support, taxes and/or fines) and given that it’s a general pool it can be mandated to not run a deficit.

Getting to that simple agreement has taken ridiculously long but with the failure of Ryan’s plan, I think we see some mature consensus around these two positions finally coming to the fore. There will certainly be fights over how best to achieve these goals and even more issues over how to best manage costs, but at least we can start with the same mission. It’s a pity that it’s taken over 20 years to get here but it’s a start.